Angiograms and Catheterizations

An angiogram is an x-ray test that uses a special iodine contrast dye and camera (fluoroscopy) to take pictures of the blood vessels. When it is used to visualize the heart arteries, is called a coronary angiogram or cardiac catheterization. Angiograms can also be used to visualize other vessels including those in the brain, abdomen and legs.

The procedure is performed in the Cardiac Catheterization Laboratory which is a specialized invasive procedure area that is staffed by highly trained registered nurses and technicians who assist the physicians. Before the procedure is started, conscious sedation is often administered to relax the patient. Local anesthesia is then given in the area where the catheters are going to be placed. The physician will then use a needle to get into the intended artery; an access point, usually in the groin (femoral artery), or in the wrist (radial artery). Catheters are advanced over a wire through the aorta into the coronary arteries and then pictures are taken. X-ray images are created by injecting a liquid, called 'contrast dye', through the catheter. Contrast dye makes the blood flowing through the blood vessels visible on an x-ray. Contrast is eliminated from the body via the kidneys in the urine. An angiogram takes about 1-2 hours to perform depending on the information needed and whether or not a stent is done at the same time.

Angiograms are often recommended to aid in the diagnosis of a variety of cardiovascular conditions including:

Coronary artery disease: blockages of the arteries to the heart.

Peripheral Artery Disease (PAD): blockages of the arteries outside of the heart.

Aneurysms: enlargements of the arteries including coronary and aorta.

Aortic arch conditions.

Cardiac catheterization is done in a special room with TV screens and X-ray devices. The doctor who performs the test is a heart specialist, also called a cardiologist. During the procedure, the doctor and his or her assistants operate the equipment in the suite. A nurse checks your vital signs, such as heart rate and blood pressure, throughout the exam.

During the test, you lie on a flat platform. The doctor selects an artery in which to insert the catheter. The femoral artery in the right groin is used most often. The skin in the groin area is numbed with local anesthesia. A small needle is then inserted through your skin and into your artery. Next, the doctor inserts a catheter into your artery through the small puncture made with the needle.

After being placed in the artery, the catheter can be pushed up into your aorta. This is the largest artery in your body. It connects directly to your heart and can be used to get into your heart chambers. Your coronary arteries, which supply blood and oxygen to your heart, also stem from the aorta. An X-ray machine is used to help guide the catheter into proper position.

Dye is used to visualize the structures of your heart and its arteries. The dye is injected into the catheter and enters your heart and heart arteries. This allows these structures to be clearly seen, as the dye used is easily seen when X-ray pictures are taken. Pictures are taken with an x-ray machine as the dye travels through your heart and heart arteries. The doctor usually takes several pictures of your heart filled with dye from different angles and positions. More than one injection of the dye is often needed. The images can be projected onto a TV or video screen so that the doctor can view your heart and its arteries during the test.

The standard test will typically take less than an hour. In more complex cases, the exam may last for several hours. The doctor may sometimes see an abnormality during the test that can be corrected during the exam. For example, a procedure called angioplasty is sometimes used to open up clogged arteries. This involves inserting a balloon catheter or other device through the catheter to open the area of blockage. Stents, which are metal mesh tubes, can be placed in the blocked artery to serve as permanent scaffolding to keep the artery open.

What is cardiac catheterization? Cardiac catheterization is a test performed to see how well your heart functions. During the procedure, a specially trained cardiologist inserts a catheter (a long, flexible, extremely thin tube) into a blood vessel, usually in the right groin, and advances it through the blood vessel to your heart.

Cardiac catheterization can reveal if there are problems with the valves, the heart muscle, or the arteries that supply blood to your heart's muscle. During the procedure we can also measure the oxygen concentration and blood pressure at the entrance to and exit from your heart.

What is involved in preparation for the test?
Special preparation is needed before the test. A brief physical exam is done to evaluate pulses in your groin and legs. If you have a weak pulse in your groin, your doctor may use a different artery to insert the catheter. Your doctor will also review your medical and surgical history. He or she may ask questions such as the following:

* Do you have a bleeding tendency or any blood disorders?
* Do you have any kidney disease or other kidney problems?
* Have you had a prior allergic reaction to contrast agent or dye?
* Do you take blood thinning medicines such as aspirin or warfarin?

Before the test, your blood is checked for kidney function and for signs of a bleeding tendency. Women of childbearing age will be screened for pregnancy. This is usually done with a urine or blood pregnancy test. Radiation from the test could harm an unborn child.

You cannot eat or drink anything for six to eight hours before the test. Dentures, eyeglasses, and jewelry, such as necklace or earrings, should be removed before the exam.

The risks, benefits, and complications of the test are usually explained to you on the day of the procedure. Some possible complications you may have from the test are as follows:

* Allergic reactions to the contrast agent used
* Bleeding in the groin
* Heart attack, which occurs in less than 1% of cases
* Irregular heartbeats called arrhythmias
* Stroke, which occurs in less than 1% of cases

If procedures are done during the exam, such as angioplasty, additional risks are involved. These will be discussed before the test by your doctor.

This test may be done on an outpatient basis. This means that you can go home after the test. However, sometimes you might have to stay in the hospital for a day or more after the test. Often, this test is used for people in the hospital who have serious or life-threatening heart conditions.

What should I do before the procedure?Generally, you should not eat or drink after midnight before the test. However, if the test is to be performed later in the day, light meals may be permitted. Ask your nurse for specific instructions.

If you take daily medications, take them as usual, using only a sip of water. If you are taking diabetes or anti-coagulant medications, check with your physician ahead of time to find out whether you should take them before the test.

What happens the day of the procedure?When you first arrive at Westchester Medical Center, you will be given an electrocardiogram and have blood drawn. A cardiac nurse will take your medical history and check your condition. Be sure to tell the nurse if you are allergic to shellfish, iodine, dyes used in other medical tests or any medications. Mention any and all allergies you may have.

A cardiologist from Westchester Medical Center's cardiac catheterization team will discuss your procedure with you. Be sure to tell the physician if you are taking the diabetes medication Metformin (Glucophage). Once the procedure has been explained and your questions have been answered, you will be asked to sign a consent form giving permission for the procedure.

You will be given a sedative, as well as a local anesthetic, before the catheter is inserted. Your urinary output will be measured during this test. A nurse will remain with you throughout the procedure. Tell your nurse immediately if you experience chest pain, bleeding, or any other symptom that concerns you. After your procedure, your nurse will help you get up and will review activity recommendations with you.

How long will the procedure last?A cardiac catheterization usually takes 45 minutes to 1 hour. Remember, this does not include the time it takes for preparation or transportation to and from the cardiac catheterization lab, which may result in a total time of two to three hours. After the procedure, you should also expect a recovery/observation time of four to six hours so that we can be sure everything is fine before you go home.

Who can come with me?
We encourage you to have someone accompany you to Westchester Medical Center on the day of the procedure. After the procedure, when you leave the hospital you must be accompanied by an adult (this is a legal requirement). People accompanying you the day of the procedure should know that:

The entire admission-through-discharge process typically takes several hours. We have a comfortable, dedicated waiting area and several cafes and cafeterias for meals.

There are strict laws protecting patient privacy and personal medical information. Our nurses and physicians will need your consent before speaking to friends and family in any detail about your condition. Let our staff know the name of the person who has come with you and specify if that person has your permission to know about and discuss your treatment.

Your cardiologist from our cardiac catheterization team will see you before you are discharged to give you any specific instructions about next steps. Once you are home, you should contact your personal physician for an appointment to discuss final results.

What happens when I am discharged?When you leave the hospital, you must be accompanied by another adult (this is a legal requirement). You should not use public transportation to get home and you should not drive yourself home.

If at all possible, you should have a friend or family members stay with you overnight to keep an eye on your progress.

Where Is the Cardiac Catheterization Center located?The Cardiac Catheterization Center at Westchester Medical Center is located in the University Hospital. Patient drop-off and parking is available directly in front of the building.